Key result
'Ablate and pace' resulted in 100% freedom from symptomatic AF compared to 79% with pulmonary vein isolation (P<0.0001), but was associated with a higher rate of persistent AF (58% vs 8%, P<0.0001).
Why the study?
Does 'ablate and pace' compared to pulmonary vein isolation improve clinical outcomes in patients with drug-refractory atrial fibrillation?
Observational (n=244)
Does 'ablate and pace' compared to pulmonary vein isolation improve clinical outcomes in patients with drug-refractory atrial fibrillation?
Absolute Event Rate: 100% vs 79%
p-value: p=<0.0001
Ablate and pace is a shorter, less complex procedure that eliminates symptomatic AF recurrences better than PVI, but is associated with a higher rate of persistent/permanent AF.
May reduce symptomatic AF more than PVI but risks persistent AF; leaves open whether it improves outcomes in refractory cases.
AIMS: To compare clinical characteristics, procedure complexity, acute and long-term outcome of 'ablate and pace' (A&P) with pulmonary vein isolation (PVI) in patients with drug-refractory atrial fibrillation (AF). So far, only few small studies have compared the two procedures. METHODS AND RESULTS: We analysed retrospectively a cohort of symptomatic consecutive patients with drug-refractory AF. Group 1 included 100 patients treated with A&P and Group 2 included 144 patients treated with PVI. Group 1 patients were older (74 +/- 8 vs. 56 +/- 9 years; P < 0.0001), had lower left ventricular ejection fraction (50 +/- 13% vs. 59 +/- 7%; P < 0.05), and a lower prevalence of paroxysmal AF (46% vs. 65%; P < 0.05). Acute success was not statistically different (98% vs. 92.3%, P = ns). Group 1 patients had shorter procedure time and lower radiation exposure with respect to Group 2 patients (70 +/- 15 vs. 204 +/- 58 min, and 8 +/- 4 vs. 57 +/- 22 min; P < 0.0001, respectively). After a median follow-up of 29 months (I, III quartile; 15, 40 months) vs. 25 months (I, III quartile; 8, 36 months) (P = ns), all the patients in Group 1 were free of symptomatic AF, while 113 patients (79%) of Group 2 were in stable sinus rhythm (P < 0.0001). Persistent or permanent AF has been documented in 58 patients (58%) of Group 1 vs. 11 (8%) of Group 2 (P < 0.0001). CONCLUSION: In this series (i) patients treated with A&P and PVI for drug-refractory AF showed significant differences in clinical profile; (ii) A&P is a shorter and less complex procedure, but is associated with a higher rate of persistent AF; (iii) symptomatic recurrences of paroxysmal AF were more frequent in PVI group. Randomized studies appear necessary to identify the best strategy in selected cases.
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Proclemer et al. (2008) conducted an observational in Drug-refractory atrial fibrillation (n=244). 'Ablate and pace' (A&P) vs. Pulmonary vein isolation (PVI) was evaluated on Freedom from symptomatic AF (p=<0.0001). 'Ablate and pace' resulted in 100% freedom from symptomatic AF compared to 79% with pulmonary vein isolation (P<0.0001), but was associated with a higher rate of persistent AF (58% vs 8%, P<0.0001).